JP4575749B2 - Endoscopic clip device - Google Patents

Description

  The present invention relates to an endoscope clip device that is used through a treatment instrument insertion channel of an endoscope in order to perform hemostasis or marking in a living body or the like.

  Clipping treatment for hemostasis and marking in a luminal organ etc. is performed by passing the clip device through the treatment instrument insertion channel of the endoscope. If it is pulled out from the treatment instrument insertion channel of the endoscope and reloaded with a clip, the operation becomes too complicated.

Therefore, an operation wire arranged in series in a state where a plurality of clips are constricted in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, and is movable in the axial direction in the sheath. An endoscopic clip device has been devised that is configured so that a plurality of clips can be sequentially pushed out from the distal end of the sheath and each clip can be opened once and then closed (for example, Patent Document 1).
JP 2002-330972 A

  However, in the conventional endoscope clip device described in Patent Document 1, a plurality of clips arranged in the distal end of the sheath are individually connected to the distal end of the operation wire by a ligation wire or the like. Therefore, the more the clip is located at the rear, the more the ligating wire is in an arrangement state, and the structure becomes cluttered and the smooth operation is not the case.

  Therefore, the present invention can arrange a plurality of clips in an orderly and concise manner within the distal end of the sheath, can perform a continuous clipping procedure with a smooth operation, and can place the clips safely in the body. It is an object of the present invention to provide an endoscopic clip device that can be used.

  In order to achieve the above object, the clip device for an endoscope of the present invention is arranged in series in a state where a plurality of clips are respectively constricted in the distal end of a sheath inserted into and removed from the treatment instrument insertion channel of the endoscope. Endoscopic clips constructed such that a plurality of clips can be sequentially pushed out from the distal end of the sheath by an operation wire disposed in the sheath so as to be movable back and forth in the axial direction, and each clip is opened once and then closed. In the apparatus, a connecting claw that is bent outward is formed at the rear end of each clip, and the portion near the tip of each clip is positioned adjacent to the front side when the clip is in a squeezed state. An engaging hole is formed to be engaged with the connecting claw of the clip to be inserted, a plurality of clips are connected by the connecting claw and the engaging hole, and the protruding end portion of the connecting claw is rounded. Those which are.

  Each clip is formed by a pair of leaf spring pieces arranged facing each other in the opening and closing direction, a connecting claw is formed at the rear end portion of each leaf spring piece, and an engagement hole is formed by each leaf spring piece. When the clip spreads, it is preferable that the connection claw of the clip and the engagement hole of the clip located adjacent to the front side are disengaged.

  According to the present invention, since the plurality of clips are directly connected in series in the distal end of the sheath and no separate member is required for connection, the plurality of clips are arranged orderly and simply in the distal end of the sheath. In addition, the continuous clipping procedure can be performed smoothly, and the tip of the connecting nail is formed in a rounded shape, so the clip can be safely inserted into the body without damaging the surrounding body mucous membrane. Can be placed in a stable state.

  A plurality of clips are arranged in series in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, respectively, and a plurality of operating wires are arranged in the sheath so as to be movable forward and backward in the axial direction. In a clip device for an endoscope that is configured so that the clips can be sequentially pushed out from the distal end of the sheath and then closed once after each clip is opened, the connecting claw bent outward at the rear end of each clip In addition, an engaging hole is formed in the vicinity of the tip of each clip. The engaging hole is engaged in a state in which the connecting claw of the clip located adjacent to the front side of the clip is inserted when the clip is narrowed. Thus, the plurality of clips are connected by the connecting claw and the engaging hole, and the protruding end portion of the connecting claw is formed in a rounded shape.

Embodiments of the present invention will be described with reference to the drawings.
2 is a side sectional view of the vicinity of the distal end of the endoscope clip device, FIG. 3 is a plan sectional view, and 1 is a flexible insertion / removal channel for a treatment instrument insertion channel of an endoscope (not shown). Sheath. The sheath 1 is formed of, for example, a coil pipe in which a stainless steel wire is closely wound with a constant diameter, and has a diameter of about 2 to 3 mm and a length of about 1 to 2 m.

  An operation wire 2 that can be moved back and forth in the axial direction from the proximal end side is inserted in the sheath 1, and the operation wire 2 is operated by an operation from an operation unit that is connected to the proximal end side (not shown) of the sheath 1. Is moved forward and backward.

  A plurality (three in this embodiment) of the clips 3 (3A, 3B, 3C) are arranged in series in the distal end portion of the sheath 1 in such a manner that they are constricted. A plurality of clips 3 are sequentially pushed out from the distal end of the sheath 1 so that the clips 3 can be once opened and then closed.

  A connecting member 5 that is detachably connected to the rearmost clip 3 </ b> C is fixedly connected to the distal end of the operation wire 2 via a connecting pipe 6. Further, a metal or plastic cylindrical tip 7 is fixedly attached to the most distal portion of the sheath 1.

  Each clip 3 is formed by a pair of leaf spring pieces 30 made of, for example, a stainless steel plate material for springs, which are arranged facing each other in the opening / closing direction, and each pair of leaf spring pieces 30 is formed outside the sheath 1 by the clip 3. Is engaged with a state of being passed through a fastening ring 4 for forcibly closing.

  4 shows a pair of leaf spring pieces 30 in an unloaded state where no external force is applied. Each leaf spring piece 30 has a rear portion 31 facing in a direction parallel to the axis of the sheath 1 and an intermediate portion. 32 is opened at the front, and the leading portion 33 is formed by being bent at the boundary portion between the portions 31, 32, 33 so that 33 is opened at a larger angle than the intermediate portion 32. ing.

  Further, the rear portion 31 and the intermediate portion 32 of the leaf spring piece 30 are formed to be narrow so that they can pass through the fastening ring 4, and the front portion 33 excludes the vicinity of the boundary with the intermediate portion 32. It is formed wide so that it cannot be fitted into the fastening ring 4.

  A connecting claw 34 that is bent outward is formed at the rear end of each leaf spring piece 30. In this embodiment, the connecting claw 34 is bent obliquely backward at an angle of about 45 ° and is thin. It is formed in width. And the protrusion part 34a of each connection nail | claw 34 is formed in the rounded shape of the state by which the ridgeline and the corner | angular part were all rounded smoothly.

  In addition, an engagement hole 37 into which the coupling claw 34 of the leaf spring piece 30 positioned adjacent to the front side is inserted and engaged is formed in the vicinity of the front end of each leaf spring piece 30 so that the plurality of clips 3 are connected in series. Can be connected to.

  A clip claw 35 is formed at the foremost portion of each leaf spring piece 30 so as to be bent toward the inside in order to eat the living tissue at the time of clipping. However, the folding positions of the clip claws 35 are slightly shifted in the pair of leaf spring pieces 30 so that the clip claws 35 of the pair of leaf spring pieces 30 do not collide with each other when the clip 3 is closed.

  Further, each clip claw 35 interferes with the rear portion 31 of the leaf spring piece 30 located adjacent to the front side when the leaf spring piece 30 is constricted in the sheath 1. A cutout 36 for avoiding is formed, whereby the clip claw 35 has a gate shape.

  FIG. 5 shows a clamp ring 4. The clamp ring 4 is formed in a tapered shape with an outer surface having a circular cross-sectional shape and gradually decreasing in diameter toward the front side, and an inner surface 4a is passed through a pair of leaf spring pieces. It is formed in a rectangular cross-sectional shape according to the cross-sectional shape of 30.

  FIG. 6 shows a state in which the rearward portion 31 of the clip 3 is passed through the fastening ring 4, and the clip 3 has the rearward portions 31 of the pair of leaf spring pieces 30 fitted together in the fastening ring 4. When the leaf spring pieces 30 are not opposed to each other and are not housed in the sheath 1, no external force acts on the leaf spring pieces 30, so that the clip 3 is largely opened.

  Then, as shown in FIG. 7, when the clamp ring 4 is shifted from the rearward portion 31 of the clip 3 toward the intermediate portion 32, the clip 3 gradually closes, and the clamp ring 4 is connected to the intermediate portion 32. When reaching the boundary position with the side portion 33, the front side portion 33 of each leaf spring piece 30 is forcibly pressed by the fastening ring 4, and the clip claws 35 of the pair of leaf spring pieces 30 cross each other. The clip 3 is tightly closed until it does.

FIG. 8 shows a state where the most advanced clip 3A and the second clip 3B are connected.
Each clip 3 is elastically deformed into a constricted state by being housed in the sheath 1, and the connecting claw 34 at the rear end of the most advanced clip 3A is inserted into the engagement hole 37 of the second clip 3B. Thus, the most advanced clip 3A and the second clip 3B are connected in a state of moving together in the axial direction of the sheath 1.

  Since the notch 36 is formed in the clip claw 35 of the second clip 3B, the clip claw 35 of the second clip 3B in the closed state does not interfere with the most advanced clip 3A. Further, the connecting claw 34 of the most advanced clip 3A is formed to have a length that does not penetrate outward from the engagement hole 37 of the second clip 3B, and as a result, it moves smoothly without being caught on the inner surface of the sheath 1. can do.

  When the second clip 3B is in an open state, the engagement hole 37 of the second clip 3B is disengaged from the connecting claw 34 of the most advanced clip 3A, and the most advanced clip 3A and the second clip 3B The connection of is released. The connecting portion between the second clip 3B and the rearmost clip 3C and the connecting portion between the rearmost clip 3C and the connecting member 5 shown in FIG. 30 are directly connected in series by each connecting claw 34 and the engaging hole 37.

  As shown in FIG. 2, the cylindrical tip 7 attached to the most distal portion of the sheath 1 is formed in a tapered cylindrical shape having a tapered inner diameter. It is formed smaller than the end outer diameter.

  Further, as shown in FIG. 9, the tip portion of the tip 7 is in a direction parallel to the axis so that when the collar 4 is pushed from behind, the diameter thereof is elastically deformed so as to be expanded. It is formed in a shape divided by a plurality of slits 7b. In this embodiment, three slits 7b are provided at intervals of 120 °, but four or more may be provided at intervals of 90 °.

  When the endoscope clip device configured as described above is used, as shown in FIG. 2, the clips 3 are not connected to each other in a state where the clips 3 are constricted and connected in the sheath 1. It is passed through the treatment instrument insertion channel of the endoscope.

  When the distal end of the sheath 1 is directed to the target affected part in the body, the operation wire 2 is pushed from the proximal end side, and thereby three clips 3A and 3B connected in series as shown in FIG. , 3C moves forward in the sheath 1 and the tip of the most advanced clip 3A passes through the tip 7.

  Then, by further pushing in the operation wire 2, as shown in FIG. 11, the intermediate portion 32 and the leading portion 33 of the most advanced clip 3A are pushed forward from the tip tip 7, and the most advanced clip. 3A is fully opened.

  At this time, the fastening ring 4 is stopped at the distal tip 7, but when the operation wire 2 is pushed in with a greater force, the fastening ring 4 is elastically deformed to expand the distal tip 7, as shown in FIG. 12. The fastening ring 4 jumps out from the tip of the tip 7.

  Then, since the outer diameter of the rear end portion of the clamp ring 4 is larger than the tip inner diameter of the tip chip 7, the clamp ring 4 can not go back and return to the tip chip 7, and the cutting edge clip 3A that is wide open can be removed. In this state, it can be pressed against the target affected area.

  Therefore, as shown in FIG. 13, when the operation wire 2 is pulled toward the proximal end side, a pair of cutting-edge clips 3 </ b> A in a state where the rear end of the fastening ring 4 is in contact with the distal end surface of the distal end tip 7. The leaf spring piece 30 is drawn into the sheath 1, and the fastening ring 4 is moved to a position closer to the tip of the clip 3 at the same time, so that the most advanced clip 3A is closed and bitten in the affected area. become.

  Then, as shown in FIG. 14, when the fastening ring 4 is engaged with the boundary portion between the intermediate portion 32 and the leading portion 33 of the leading edge clip 3A, the leading edge clip 3A is tightly closed. The operation wire 2 can no longer be pulled.

  When that happens, as shown in FIG. 15, the operation wire 2 is pushed again into the distal end side, and as shown in FIG. 16, if the second clip 3B is pushed out from the distal end of the distal end tip 7, When the second clip 3B is opened, the connection between the cutting edge clip 3A and the second clip 3B is released, and the cutting edge clip 3A is left in the body with the affected part clipped, and at the same time the second clip By 3B, a clipping operation can be performed on the next target affected area.

  When the clipping operation by the second clip 3B is finished, the clipping operation by the last clip 3C can be continuously performed in the same manner, while the clip device is inserted into the treatment instrument insertion channel of the endoscope. There is no need to take off.

  FIG. 1 shows the clip 3 in a state where it is eaten at the affected part and is left in the body as described above, and a connecting claw 34 is formed at the rear end of the clip 3 so as to be bent outward. However, since the protruding end portion 34a of each connecting claw 34 is formed in a rounded shape, the clip 3 can be safely placed in the body without damaging the surrounding body mucous membrane with the connecting claw 34. Can do.

  In addition, this invention is not limited to the said Example, For example, the shape of the protrusion part 34a of the connection nail | claw 34 does not necessarily need to round all the ridgelines and corner | angular parts, and it is illustrated by FIGS. In addition, it may be rounded to such an extent that the mucous membrane is not damaged when the surrounding mucous membrane is touched.

  In the example shown in FIG. 17 to FIG. 19, the protruding end portion 34 a is rounded by rounding a part of each ridge line of the protruding end portion 34 a of the connecting claw 34 to eliminate the corner, and the example shown in FIG. 20. Then, the protruding end portion 34a is formed in a round bar shape, and the protruding end is rounded into a spherical shape.

It is a perspective view of the state where the clip device for endoscopes of the example of the present invention was detained in the body. It is side surface sectional drawing of the front-end | tip vicinity of the clip apparatus for endoscopes of the Example of this invention. It is a plane sectional view near the tip of the clip device for endoscopes of the example of the present invention. It is a perspective view of a pair of leaf | plate spring pieces of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of a clamp ring of the clip device for endoscopes of the example of the present invention. It is side surface sectional drawing of the state which the clip of the clip apparatus for endoscopes of the Example of this invention opened. It is side surface sectional drawing of the state which the clip of the clip apparatus for endoscopes of the Example of this invention closed. It is side surface sectional drawing which shows the connection state of the clip of the clip apparatus for endoscopes of the Example of this invention. It is a perspective view of the front-end | tip chip | tip of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is side surface sectional drawing which shows operation | movement at the time of use of the clip apparatus for endoscopes of the Example of this invention. It is a fragmentary perspective view which shows the 1st modification of the protrusion part of the rear end of the connection nail | claw of the clip apparatus for endoscopes of the Example of this invention. It is a fragmentary perspective view which shows the 2nd modification of the protrusion part of the rear end of the connection nail of the clip device for endoscopes of the Example of this invention. It is a fragmentary perspective view which shows the 3rd modification of the protrusion part of the rear end of the connection nail | claw of the endoscope clip apparatus of the Example of this invention. It is a fragmentary perspective view which shows the 4th modification of the protrusion part of the rear end of the connection nail of the clip device for endoscopes of the Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Sheath 2 Operation wire 3 (3A, 3C, 3D) Clip 4 Fastening ring 5 Connection member 7 Tip tip 7b Slit 30 Leaf spring piece 31 Rear part 32 Intermediate part 33 Front part 34 Connection claw 34a Protrusion part 35 Clip Claw 37 engagement hole

Claims (2)

A plurality of clips are placed in series in the distal end of the sheath inserted into and removed from the treatment instrument insertion channel of the endoscope, respectively, and the operation wire is disposed in the sheath so as to be movable back and forth in the axial direction. In an endoscopic clip device configured to sequentially extrude a plurality of clips from the distal end of the sheath and then close each clip once opened,
A connecting claw that is bent outward is formed at the rear end of each clip, and is located adjacent to the front side of the clip in the vicinity of the front end when the clip is in a squeezed state. An engagement hole that is locked in a state in which the connection claw of the clip is inserted is formed, and the plurality of clips are connected by the connection claw and the engagement hole,
A clip device for an endoscope, wherein a protruding end portion of the connecting claw is formed in a rounded shape. Each clip is formed by a pair of leaf spring pieces arranged facing each other in the opening and closing direction, the connection claw is formed at a rear end portion of each leaf spring piece, and the engagement hole is formed by each of the engagement holes. 2. The inner part according to claim 1, wherein the clip is formed in a portion near the tip of the leaf spring piece, and when the clip spreads, the connection claw of the clip is disengaged from the engagement hole of the clip located adjacent to the front side. Endoscopic clip device.

Images